Rural healthcare providers face an ongoing crisis due to budget and staffing woes, creating a landscape where such hospitals need trustees who have their fingers on the pulse of the industry at large, according toHospitals & Health Networks.

As healthcare transitions to a value-based model, reimbursement issues are a major obstacle for rural providers in general, and in particular for so-called "tweener" hospitals that are too large to be classified as critical access hospitals but too small for the financial risk of prospective payment systems, the article noted. For hospitals that fall into this gap, there are often few choices but to cut services or seek affiliation with a larger system. The final decision on such matters comes down to board members, who are confronted with a wave of new, increasingly complex responsibilities, HHN reported.

These would be daunting challenges for any hospital trustee, but they are heightened in rural settings by the tight-knit community, according to the article.

"When you're the trustee of a small rural hospital, you are much more likely on a Saturday morning or in the evening at a football game to run into a constituent of the hospital, who may have some praise or some concern about something going on at the hospital," Tom Bell, president and CEO of the Kansas Hospital Association, told H&HN. However, rural hospital trustees must also pay attention to trends bigger than their hospitals or communities, understanding the nature of their state's Medicaid programs, changes in payment models and the wave of consolidation within health insurance.

This can mean changing the profile of what hospitals look for in board members, seeking experts in fields such as process improvement or patient safety rather than those with more traditional experience, like CEOs or chief financial officers. They should even look to groups such as farmers, who have experience with both understanding the nature of their communities and adapting to changes in government payment systems, said Tim Putnam, president and CEO of the Margaret Mary Health, a critical access facility in Batesville, Indiana.